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A considerable proportion of patients with chronic obstructive pulmonary disease (COPD) entering pulmonary rehabilitation (PR) report psychological distress, which is often accompanied by poor physical health status. Mindfulness-based cognitive therapy (MBCT) has been shown to improve psychological and physical outcomes in other chronic diseases. We therefore evaluated the efficacy of MBCT as an add-on to a standard PR programme in COPD.COPD patients eligible for PR were cluster randomised to receive either an 8-week, group-based MBCT programme as an add-on to an 8-week PR programme (n=39), or PR alone (n=45). The primary outcomes of psychological distress and physical health status impairment were measured with the Hospital Anxiety and Depression Scale (HADS) and the COPD Assessment Test (CAT) before randomisation (T1), mid- (T2) and post-intervention (T3), and at 3 (T4) and 6 (T5) months' follow-up .A statistically significant time×arm effect was found for the HADS (Cohen's d =0.62, 95% CIs ( d )=0.18-1.06, p=0.010). The treatment effect on the CAT failed to reach statistical significance ( d =0.42, 95% CIs ( d )=-0.06-0.90, p=0.061).MBCT showed a statistically significant and durable effect on psychological distress, indicating that MBCT may be an efficacious add-on to standard PR programmes in COPD., Competing Interests: Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2018.)

Long-term oxygen therapy (LTOT) improves survival for patients afflicted with severe chronic obstructive pulmonary disease and may also reduce the incidence of repeat hospitalization due to exacerbations. When properly dosed and titrated, LTOT has also been shown to improve exercise tolerance, thereby enhancing the overall health-related quality of life for this growing patient population. Equipment used to provide LTOT is undergoing a radical transformation, with newer delivery devices offering a sharp contrast to older, more traditional home oxygen equipment. This newer approach to providing LTOT-commonly referred to as "non-delivery technology"-affords LTOT users unprecedented freedom, since they are no longer dependent on home-care providers for repeat deliveries to replenish or replace depleted oxygen contents. Instead, non-delivery LTOT equipment is self-sufficient and able to provide all of the oxygen needed to meet both stationary and ambulatory requirements. However, several models of the newer LTOT equipment have certain operational and performance limitations. Accordingly, in order to preclude unintended desaturation with newer LTOT devices, each patient must undergo an individualized pulse-oximetry titration study by a knowledgeable and experienced respiratory therapist to ensure optimum dosing under all conditions of use.